艾司西酞普兰与度洛西汀治疗抑郁症有效性与安全性的Meta分析  

Effectiveness and Safety of Escitalopram and Duloxetine in the Treatment of Depression:a Meta-analysis

作　　者：路淑淑 李文馨 张贝贝 李智强[2] 靳英辉 侯宁 LU Shushu;LI Wenxin;ZHANG Beibei;LI Zhiqiang;JIN Yinghui;HOU Ning(School of Pharmacy,Shandong University,Jinan 250012,China;Shandong Mental Health Center,Jinan 250013,China;Shandong Institute for Food and Drug Control,Jinan 250101,China;Center for Evidence-based Nursing,Tianjin University of TCM,Tianjin 300193,China;Center for Evidence-based Medicine and TranslationalMedicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Dept. of Pharmacy,ShandongProvincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学药学院,济南250012 [2]山东省精神卫生中心,济南250013 [3]山东省食品药品检验研究院,济南250101 [4]天津中医药大学循证护理中心,天津300193 [5]武汉大学中南医院循证与转化医学中心,武汉430071 [6]山东大学附属省立医院药学部,济南250021

出　　处：《中国药房》2018年第10期1395-1400,共6页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81603496)

摘　　要：目的:系统评价艾司西酞普兰与度洛西汀治疗抑郁症的有效性和安全性,为临床治疗提供循证参考。方法:计算机检索Pub Med、万方数据库、中文科技数据库、中国期刊全文数据库、中国生物医学文献数据库,收集艾司西酞普兰(试验组)与度洛西汀(对照组)治疗抑郁症的临床随机对照试验(RCT),提取数据并按照Cochrane系统评价员手册5.3推荐的偏倚风险评估工具评价文献质量后,采用Rev Man 5.3软件对数据进行Meta分析。结果:共纳入25项RCT,合计2 621例患者。Meta分析结果显示,两组患者治疗第1、2、4、6、8周的总有效率及治疗第4、6、8周的治愈率比较,差异均无统计学意义(P>0.05)。两组女性患者总有效率[RR=0.96,95%CI(0.88,1.05),P=0.42]、女性患者治愈率[RR=0.91,95%CI(0.78,1.06),P=0.24]、老年患者总有效率[RR=0.96,95%CI(0.84,1.11),P=0.61]、老年患者治愈率[RR=0.90,95%CI(0.54,1.49),P=0.69]比较,差异均无统计学意义。试验组患者便秘[RR=0.59,95%CI(0.42,0.81),P=0.001]、口干[RR=0.65,95%CI(0.51,0.82),P=0.000 4]、恶心[RR=0.68,95%CI(0.56,0.83),P=0.000 2]、食欲降低[RR=0.74,95%CI(0.55,0.99),P=0.04]的发生率均显著低于对照组,差异均有统计学意义。结论:艾司西酞普兰与度洛西汀治疗抑郁症的有效性相当,但在安全性方面艾司西酞普兰更优。OBJECTIVE： To systematically evaluate the effectiveness and safety of escitalopram and duloxetine in the treatment of depression, and provide evidence-based reference for clinical treatment. METHODS： Retrieved from Pub Med,Wanfang database,VIP,CNKI and CBM,randomized controlled trials（RCTs） about escitalopram（trial group） and duloxetine（control group）in the treatment of depression were collected. Meta-analysis was conducted by using Rev Man 5.3 software after data extraction and quality evaluation according to bias risk assessment tool recommended by system evaluator manual 5.3.RESULTS：Finally 25 RCTs were included,involving 2 621 patients. The results of Meta-analysis showed that there was no statistical significance in total response rate between 2 groups after 1,2,4,6,8 weeks of treatment or cure rate between 2 groups after 4,6,8 weeks of treatment（P0.05）. There was no statistical significance in total response rate [RR=0.96,95%CI（0.88,1.05）,P=0.42] or cure rate [RR=0.91,95%CI（0.78,1.06）,P=0.24] of female patients,as well as total response rate [RR=0.96,95%CI（0.84,1.11）,P=0.61] or cure rate [RR=0.90,95%CI（0.54,1.49）,P=0.69] of elderly patients between 2 groups. The incidence of constipation [RR=0.59,95%CI（0.42,0.81）,P=0.001],dry mouth [RR=0.65,95%CI（0.51,0.82）,P=0.000 4],nausea [RR=0.68,95% CI（0.56,0.83）,P=0.000 2] and decreased appetite [RR=0.74,95% CI（0.55,0.99）,P=0.04] in trial group were significantly lower than control group,with statistical significance. CONCLUSIONS：The effectiveness of escitalopram is similar to duloxetine in the treatment of depression,but the safety of escitalopram is better than duloxetine.

关 键 词：艾司西酞普兰 度洛西汀 抑郁症 有效性 安全性 META分析 

分 类 号：R971[医药卫生—药品]